Key result
Multidisciplinary hematology evaluation is recommended before prolonged DAPT in stable CAD with baseline thrombocytopenia.
Why the study?
Baseline thrombocytopenia is relatively common in patients referred for PCI, and its detection may have implications for long-term antiplatelet medication prescription and adherence.
Multidisciplinary evaluation with hematological counseling is recommended before planning prolonged dual antiplatelet therapy in patients with stable CAD and baseline thrombocytopenia.
May inform hematology input before prolonged DAPT in thrombocytopenic stable CAD; leaves open prospective validation.
Baseline thrombocytopenia (TP) is relatively common in patients referred for percutaneous coronary intervention (PCI). Its detection may have implications for long-term antiplatelet medication prescription and adherence. The aim of this article is to review several practical aspects in managing patients with baseline TP and stable coronary artery disease (CAD). Moving from two clinical cases, we tried to picture cardiological scenarios associated with baseline TP and to provide flow charts for patient's management which take into consideration both the cardiological and the hematological conditions. TP in patients with stable CAD on antiplatelet treatment may follow diverse clinical courses depending upon TP inferred etiology, baseline degree of thrombocytopenia and its time course as outlined by previous complete blood counts, when available. Evaluation of these three parameters may guide the planning of further patient work-up and the choice of the most appropriate cardiological treatment (medical, invasive with stent implantation or coronary artery bypass). A multidisciplinary evaluation comprehensive of hematological counseling is also recommended in these patients before planning prolonged dual anti-platelet therapy.
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Morici et al. (2013) conducted a review in Stable coronary artery disease with baseline thrombocytopenia. Multidisciplinary management and antiplatelet therapy was evaluated. Multidisciplinary evaluation including hematological counseling is recommended for patients with stable coronary artery disease and baseline thrombocytopenia before prolonged dual antiplatelet therapy.
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